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If you live long enough, anything can happen. Here’s an example that proves this rule: I find myself agreeing (in part) with Robert Raich*.

In his opinion segment of the Marketplace radio show last week (link, starting @ 10 min, 10 sec), Raich argued that 1) most likely the Supreme Court, when it rules this month, will strike down the “individual” health insurance mandate provisions of the 2010 Affordable Care Act, and leave most of the rest of the Act in place and 2) that will push the U.S. towards a tax-funded, single-payer health care system.

Raich observes that much of the remainder of the affordable care act is popular. U.S. voters are particularly pleased with the provisions that extend coverage, some of which have already taken effect, especially the ban on coverage exclusion based on pre-existing conditions, which takes effect in January, 2014. He argues that it will be hard to dial these benefits back, so the government will have to find a way to fund them. The obvious answer is taxes: there is no constitutional question about the federal government’s power to tax. The legal dispute is whether forcing individuals to buy insurance is an over-reaching interpretation of the federal government’s power to “regulate interstate commerce”, like “forcing individuals to buy broccoli” (more).

And Raich argues this would be a good thing: a single-payer approach would be an efficient and straightforward way to fund an inclusive health care system in the U.S. And, it would redistribute income by making health care (18% of the economy) available to all on affordable terms, with the cost paid via the progressive federal tax system.

I think Raich is right that you can’t un-ring the bell on inclusive health care. Once it has been promised, even enacted into law, it will be very hard to take it back. And the data do show that the private system of health care administration and funding is a significant contributor to the high cost of U.S. health care.

But, U.S. health care is grossly inefficient. It delivers results no better than other OECD countries at about twice the cost. The main drivers of this are: high prices almost everywhere, over-utilization of advanced care, regulatory balkanization leading to monopolistic pricing by powerful providers in regional markets, and slow change in its business processes. I’ve written about this in various prior posts**.

The federal government already exercises great control over the health care system: it pays for about 40% of U.S. health care on-budget and over 50% including tax subsidies. It runs some of the largest health care providers: the military and veterans’ systems. And, CMS, part of the Department of Health and Human Services, determines reimbursement rates for Medicare and Medicaid, which are the economic template for the entire U.S. industry.

Yet the feds have not been able to “bend the cost curve” significantly. It’s a big leap of faith to believe that putting the whole problem in the hands of the feds will lead to the best answer. I would agree that in some areas the big federal stick is needed, particularly negotiating with the most powerful economic interests.